Can Smoking Help Ulcerative Colitis?

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There's no doubt that smoking causes a whole host of health problems—lung cancer, heart disease, and chronic obstructive pulmonary disease, to name just a few. In fact, it's America's No. 1 cause of disability, disease, and death.

But there's a strange twist for people with the digestive disease ulcerative colitis (UC). Something in tobacco may help relieve symptoms and prevent new cases. It's no reason to pick up the habit, but it may give scientists a promising area of research for new treatments. 

Smoking's Different Effects on Bowel Disease

UC is closely related to another digestive disease, Crohn's disease. Together, they're known as inflammatory bowel disease (IBD). But they have one striking difference: Smoking increases the risk of developing Crohn's disease but decreases the risk of UC.

While many people with Crohn's disease are smokers, most of those with UC are not. Many used to smoke, however. Quitting increases the risk of UC within two to five years—and the effect lasts up to 20 years.

What's more, when smokers with UC quit, they're likely to have a flare-up of symptoms. Some studies suggest nonsmokers tend to have more severe cases of the disease. They may endure more hospitalizations, may require higher doses of medications, and are more likely to need surgery.

Nicotine May Reduce Inflammation

Researchers believe that although cigarette smoke contains many dangerous compounds, nicotine itself may have some anti-inflammatory effects. This may reduce the swelling, irritation, and sores in the large intestine that occur in people with UC.

More studies are being done to discover how nicotine or other components of cigarette smoke may be beneficial for UC. Once scientists find the answers, they may be able to use them to develop new treatments for UC. These treatments could reduce the risk of UC without the life-threatening hazards of smoking.

The Benefits Don't Outweigh Smoking's Risks

Some studies have shown that resuming smoking at a low level can relieve symptoms in people with UC for whom traditional treatments don't work. However, the results are controversial. Another review of all the medical literature looked at many types of nicotine therapy—including cigarettes, patches, gum, and enemas—and found that none was effective for people with UC.

Keep in mind that smoking causes a wide range of harmful conditions. This includes other gastrointestinal conditions, such as Crohn's disease, liver disease, gallstones, and ulcers. Work with your doctor to find the treatment plan that best relieves your symptoms without increasing your risk for other problems. Components of your plan may include dietary changes, medications, and surgery.

Key Takeaways

  • Nicotine may have anti-inflammatory effects that reduce the swelling, irritation, and sores in the large intestine that occur in people with ulcerative colitis.

  • More studies are being done, and the answers could lead to new treatments.

  • At this point, any benefits of smoking don't outweigh the health risks, which include other gastrointestinal conditions such as Crohn's disease, liver disease, gallstones, and ulcers.
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Apr 29

  1. Higuchi L, et al.A prospective study of cigarette smoking and the risk of inflammatory bowel disease in women. The American Journal of Gastroenterology. September 2012, vol. 107, no. 9, pp. 1399-406.

  2. Lakhan S and Kirchgessner A. Anti-inflammatory effects of nicotine in obesity and ulcerative colitis. Journal of Translational Medicine. Aug. 2, 2011, vol. 9, no. 129.

  3. DrugFacts: Cigarettes and Other Tobacco Products. National Institute on Drug Abuse.

  4. Rosenfeld G and Bressler B. The Truth About Cigarette Smoking and the Risk of Inflammatory Bowel Disease. The American Journal of Gastroenterology. September 2012, vol. 107, no. 9, pp. 1407-8.

  5. van der Heide F, et al. Effects of active and passive smoking on Crohn’s disease and ulcerative colitis in a cohort from a regional hospital. European Journal of Gastroenterology & Hepatology. March 2011, vol. 23, no. 3, pp. 255-61.

  6. Cabré E and Domènech E. Impact of environmental and dietary factors on the course of inflammatory bowel disease. World Journal of Gastroenterology. Aug. 7, 2012, vol. 18, no. 29, pp. 3814-22.

  7. Calabrese E, et al. Low-dose smoking resumption in ex-smokers with refractory ulcerative colitis. Journal of Crohn’s & Colitis. August 2012, vol. 6, no. 7, pp. 756-62.

  8. S. Nikfar et al. Systematic review and meta-Analysis of the Efficacy and Tolerability of Nicotine Preparations in Active Ulcerative Colitis. Clinical Therapeutics. December 2010, vol. 32, no. 14, pp. 2304-15.

  9. Bastida G and Beltrán B. Ulcerative colitis in smokers, non-smokers and ex-smokers. World Journal of Gastroenterology. June 14, 2011, vol. 17, no. 22, pp. 2740-7.

  10. Ulcerative Colitis. National Institute of Diabetes and Digestive and Kidney Diseases.

  11. Smoking and Your Digestive System. National Institute of Diabetes and Digestive and Kidney Diseases.

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